Provider Demographics
NPI:1649833450
Name:PERRY, KEONA ROCHELLE (LPCA)
Entity type:Individual
Prefix:
First Name:KEONA
Middle Name:ROCHELLE
Last Name:PERRY
Suffix:
Gender:F
Credentials:LPCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:575 CASTLE RISING RD APT 3A
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28314-7501
Mailing Address - Country:US
Mailing Address - Phone:910-304-7866
Mailing Address - Fax:
Practice Address - Street 1:2018 FORT BRAGG RD STE 124
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28303-7037
Practice Address - Country:US
Practice Address - Phone:910-485-3332
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-17
Last Update Date:2019-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA14171101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health